Practice Type: Rural

Improving resilience and recovery from traumatic events using the ECHO model

Most adults in the US experience a traumatic event at some point in their lives. Trauma is linked to the development of mental health disorders, increased suicidality, work and relationship impairment and increased physical health conditions. Effective treatments exist, but many people don’t receive these treatments because of a lack of providers who are trained in evidence-based, trauma-focused treatment, especially those in rural or underserved areas.

This project aims to build, implement and test an ECHO (Extension for Community Healthcare Outcomes) model for disseminating evidence-based, trauma-focused care, both psychotherapy and pharmacotherapy approaches, to providers working with underserved communities in Washington state. The team will evaluate the impact and reach of the training model, with the goal of expanding the ECHO approach to improve trauma-informed mental health care throughout Washington.

Brain Injury Rehabilitation: Improving the Transition Experience (BRITE)

Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Persons with TBI receiving care in inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor community reintegration, family stress, and other unfavorable outcomes. In a six-center randomized pragmatic comparative effectiveness study, we compare the effectiveness of two methods for transition from IRF to the community. The Rehabilitation Discharge Plan (RDP) includes patient/ family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference. 900 patients will be randomized, with caregivers also invited to participate. Assessed outcomes include societal participation, quality of life, caregiver well-being, and use of healthcare resources at 6-months and 12-months post-discharge.

Using technology to optimize Collaborative Care management of depression in urban and rural cancer centers (SCOPE)

This project aims to improve the treatment of depression in cancer patients. Up to 25% of people with cancer will become clinically depressed, significantly affecting their quality of life, functioning, and ability to tolerate cancer treatment. Unfortunately, about 75% of cancer patients with depression do not receive adequate treatment, and patients in rural settings are even less likely to receive adequate care. This study uses a human-centered design approach to develop, build, and test a web and mobile platform to enhance the implementation and fidelity of collaborative care management (CoCM) of depression for patients being treated at urban and rural cancer centers. In Phase I, patient-facing web and mobile applications and a clinician facing website will be developed. In Phase II, the technology-enhanced system will be compared to usual CoCM in a pragmatic effectiveness-implementation randomized controlled trial.

Re-engineering siloed systems of care through evidence-integrated design thinking

Behavioral health, including suicidal behaviors and problematic substance use, are significant public health concerns and are routinely identified by community health departments as a high priority. However, needed services are highly fragmented across multiple systems (e.g., prevention, primary care, schools). Addressing these urgent public health concerns requires decisionmakers to collaborate and coordinate services. System-level planning efforts tend to fail because adopted models are either not informed by evidence, or policy decisions do not have sufficient community buy-in and are poorly implemented.

To address this gap, our team created a hybrid approach, “System Codesign,” in which researchers and local decisionmakers form a design workgroup and collaborate to create a tailored and sustainable plan to address community public health issues. This partnership approach allows end users to be actively involved in the design process to help ensure that the outcome meets the needs and expectations of the community. The researcher’s role is to locate and synthesize research findings relevant to the community agency’s goals and assist in integrating these principles within real world programming. This new “System Codesign” approach is built from well-established participatory and implementation frameworks and incorporates evidence-informed standards in research into the energy and creativity of design thinking to support local systems. This model is expected to incorporate evidence, innovation, and local relevance into final system products.

Our research team aims to assess the acceptability and feasibility of this “System Codesign” process as a tailored implementation method for tackling complex behavioral healthcare issues. Our aim is to partner with the state Healthcare Authority (HCA) to pilot this approach with a rural Washington community, Grays Harbor County, which has a high prevalence of behavioral health needs. The proposed design workgroup will leverage cross-system participation from behavioral health, justice, law enforcement, faith-based organizations, schools, and community members.

Disseminating a user-friendly guide: Advancing the science of intervention adaptation and improving access to evidence-based psychological treatment

Adaptation of evidence-based practices and programs (EBPs) is a necessary component of the implementation process. EBPs must be adapted to function with the constraints of real-world practice settings, providers’ expertise, and patients’ needs. The science of intervention adaptation is hungry for well-defined methods of EBP adaptation to guide decision making. A how-to guide for EBP adaptation titled MODIFI: Making Optimal Decisions for Intervention Flexibility during Implementation, is under development with NIMH funding (F32 MH116623). MODIFI will be disseminated via multiple strategies locally, nationally, and internationally. Dissemination of MODIFI will improve the practice of intervention adaptation by providing practitioners with a how-to guide that is (a) evidence-based, (b) usable, and (c) supported by the expert consensus of implementation practitioners and researchers.

Rural Mental Health Integration Initiative (RMHII)

The RMHII is a partnership between the AIMS Center and Premera Blue Cross to expand access to evidence-based mental health treatment in rural areas. The AIMS Center will lead clinic selection, training, technical assistance, and practice coaching for up to 30 primary care clinics in rural Washington and Alaska.

Improving usability

While evidence-based psychosocial interventions (EBPIs) are important, their design is cumbersome, complex, overwhelming, inflexible, and minimizes factors that are crucial for quality delivery of care.

This study will work with six FQHCs across MT that were recently reorganized under Bighorn Valley Health Center’s umbrella to involve their Therapists and Care Managers in the redesign of an intervention to address their unique patient population and to capitalize on their task sharing model.

Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT)

The primary goal of this project is to quantitatively compare the treatment experience, engagement, self-reported clinical outcomes, and recovery-oriented outcomes of patients initially randomized to telepsychiatry collaborative care and telepsychiatry enhanced referral. In addition, for the subset of patients randomized to telepsychiatry enhanced referral who do not engage in treatment and are still symptomatic at 6 months, an additional goal is to quantitatively compare the treatment experience, treatment engagement, self-reported clinical outcomes and recovery-oriented outcomes of patients randomized to continued- telepsychiatry enhanced referral or phone enhanced referral. Additional goals are to gain an in-depth understanding of patients’ and providers’ treatment experiences and to examine treatment heterogeneity among subgroups of patients based on race/ethnicity, age and clinical severity.

Perinatal PCL

The Perinatal Psychiatry Consultation Line (PCL) is a free telephone consultation service for health care providers caring for patients with mental health problems who are pregnant, postpartum, or planning pregnancy. Any health care provider in Washington State can receive consultation, recommendations, and referrals to community resources from a UW psychiatrist with expertise in perinatal mental health.

Premera rural mental health initiative

The AIMS Center is partnering with Premera to support up to 30 clinics in rural Washington and Alaska to expand access to evidence-based mental health treatment. Selected clinics will receive up to $245,000 over 15 months to defray participation costs.